For which of the following patients would nitrofurantoin (Macrodantin) be contraindicated?
a. Patient with a urine phosphate of 0.9 gm/24 hr
b. Patient with a urine specific gravity of 1.024
c. Patient with bacteria in the urine
d. Patient with a creatinine clearance of 38 mL/min
ANS: D
Nitrofurantoin should not be administered to individuals with renal impairment, as indicated by a creatinine clearance of less than 40 mL/min. In the absence of good renal function, levels of nitrofurantoin in the urine are too low to be effective. Also, renal impairment reduces nitrofurantoin excretion, causing plasma levels of the drug to rise, posing a risk of systemic toxicity.
A urine phosphate of 0.9 is within acceptable limits as is a specific gravity of 1.024.
Macrodantin is indicated for cystitis and UTI, thus bacteria in the urine would be expected and not a contraindication.
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